Hospital based and Free standing Ambulatory Care

1. Hospital based and Free standing Ambulatory Care HIM 2000

2. Ambulatory Care Settings • Hospital Based Program • Emergency Services • Observation Status • Ancillary services (therapy, radiology, lab) • Ambulatory Day surgery center • Community Based Facilities • Free standing outpatient surgical centers • Birthing centers • Physician (private or group) offices • University Student clinics • Industrial health center (workers comp)

3. Ambulatory Care Continued advances in medical technology and changes in reimbursement systems that encourage delivery of care in the least-costly settings are the driving forces behind the increased hospital-based ambulatory services.

4. Ambulatory reimbursement Ambulatory payment classifications (APCs) are grouping of services rendered during outpatient visits that are similar clinically and in consumption of hospital resources. APCs are the unit of payment for Medicare hospital outpatients.

5. Chargemaster in hospital A chargemaster is a computer file that contains a list of codes and associated charges for services provided to hospital (hospital based ambulatory) patients. Most chargemasters contain the facility’s internal code for each procedure, the HCPCS code for that procedure, the associated revenue code and the facility’s charge.

6. EMTALA Emergency Medical Treatment and Active Labor Act is a federal law that imposes a legal duty on hospitals to screen and stabilize if necessary, any patient who arrives in the emergency department. The purpose of EMTALA is to prevent the “dumping” of patients who may not be able to pay for ER services.

7. Surveys - Regulatory • State licensing agency • Annual licensure renewal • CMS • Annual certification for participation

8. Surveys - Accreditation • JCAHO • AAAHC – Accreditation Association for Ambulatory Health Care • NCQA – National Committee for Quality Assurance • The Commission for the Accreditation of Freestanding Birth Centers

9. Documentation • Uniform Ambulatory Care Data Set -Data set includes patient data ietms, provider data items, and encounter data items. • Problem list • Encounter Record – any professional contact between patient and provider

10. Freestanding Ambulatory care reimbursement Ambulatory surgery center (ASC) groups provide a preset level of payments for surgical and certain other procedures performed in the ambulatory setting. Each ASC procedure falls into one of nine different groups. Each group has its own reimbursement rate.

11. Freestanding Ambulatory Care Superbill- a from used for billing purposes which includes the services which the patient received, the charges, and diagnosis and procedure codes. Coding: Current Procedural Terminology (CPT) & ICD-9-CM.

12. JCAHO • Identification • Relevant history of the illness/injury and physical findings • Diagnostic and therapeutic orders • Clinical observations, including results of treatment • Reports of procedures, tests, and results • Diagnostic impression

13. JCAHO - continued • Disposition and any pertinent instructions • Immunization record • Allergy history • Growth charts for pediatric patients • Referral information to and from agencies